Esophageal Burns

Drinking strong acid and alkaline substances Burns occurring in the esophagus are called corrosive esophageal burns (CLI) and stenosis that develops as a result of their effects corrosive esophageal stricture (CES) is called. These substances are often consumed by accident in children under the age of 6, and by children in adolescence, usually for the purpose of suicide. Drinking strong corrosive substances, especially alkalis, can cause acute perforation and death. Esophageal stenosis develops as a problem in patients who survive the acute period.
The most common factors causing SLI are the strong bases NaOH and Na2HCO3. It is the second most common cause of burns after alkalis; It is caused by acids such as HCl and H2SO4. In recent years, alkaline batteries have come to the fore as corrosive agents.

The main principles of CLI treatment are the prevention of the inflammatory event that increases the damage, bacterial colonization that can easily occur in the damaged epithelium, and the stenosis that can develop subsequently. Corticosteroids are pharmacological agents that have entered clinical use Although they are available, some authors have reported that they have no effect on preventing stenosis. Other substances used for this purpose; pentoxifylline, heparin, epidermal growth factor, sex steroids, It can be listed as metatroxate. In addition to these agents, long-term dilatations were required in the treatment of stenosis.
Acute Period: Covers the first two weeks. The esophagus is prone to infection, gangrene and perforation. The esophagus is at its most sensitive period in terms of perforation at the end of the first week and the beginning of the second week.
Catrization Period: It covers the third and fourth weeks, when dysphagia gradually progresses. Damage to the esophagus is repaired by connective tissue elements.

Stenosis Period: Stenosis occurs as a result of the contraction of the excessive fibrotic tissue that develops. It may take years for the development of stenosis to be completed.
Measures are taken against shock, laryngeal edema and aspiration pneumonia that develop in patients. An attempt is made to learn the composition, density and amount of the smoked substance. Neglecting the examination of the lips, tongue, pharynx, larynx and abdomen due to possible gastric perforations should not be done. Esophagoscopy is performed within the first 12-24 hours. After this period, the esophagus is fragile due to edema and inflammation. For this reason, esophagoscopy is risky
The inside of the patient's mouth, who is thought to have consumed a corrosive substance, is warm can be washed with water. Since the burn that occurs when drinking a corrosive substance is painful, the amount consumed is generally small. Neutralization, gastric lavage with antidote, and induction of vomiting have no place. In older children and adolescents, when the aim is to attempt suicide, it is thought that the corrosive substance is ingested in large amounts.

Bacteria easily invade the mediastinum from the burned mucosa in an esophageal burn, even though there is no perforation. First, aspiration pneumonia occurs, and then bacterial pneumonia occurs. In addition, pathological bacterial colonization easily develops on the granulation tissue in the esophagus. For these reasons, antibiotics are unquestionably used parenterally in KÖY for approximately 10 days.
The use of steroids aims to prevent or minimize the damage caused by severe fire in the early period, scarification and subsequent stenosis. Steroids are administered at a dose of 1-2 mg/Kg/day within the first 48 hours, preferably within 12 hours, for at least 3 weeks. However, steroid use is controversial.

If stenosis occurs in the esophagus, the patient is included in the dilatation program. When it reaches a sufficient width, dilatations are reduced and terminated after one year if there is no recurrence of stenosis. In patients with suspected severe stenosis, the risk of perforation is high during repeated dilatations. There is also the possibility of balloon dilation today. All of these complicated and risky procedures are performed at Göztepe Pediatric Surgery Clinic.

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